Provider Demographics
NPI:1821039199
Name:TALAMO, JILL A (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:TALAMO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 SHERIDAN DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-0000
Mailing Address - Country:US
Mailing Address - Phone:716-250-9999
Mailing Address - Fax:716-250-4177
Practice Address - Street 1:3925 SHERIDAN DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-0000
Practice Address - Country:US
Practice Address - Phone:716-250-9999
Practice Address - Fax:716-250-4177
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0121121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8828Medicare PIN